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Published on: August 28, 2018
Coronary Artery Calcification and Plaque Characteristics in People Living With HIV: A Systematic Review and
Cullen Soares1, Amjad Samara2, Matthew F Yuyun3,4,5
1Department of Medicine University of Maryland Baltimore MD.
Insights
People living with HIV have a higher prevalence of noncalcified coronary plaques but similar coronary artery calcium compared to HIV-negative individuals. Further research on plaque progression is needed to understand subclinical atherosclerosis in this population.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Individuals with HIV often exhibit a greater burden of subclinical cardiovascular disease.
- Existing data on cardiovascular disease in people with HIV require comprehensive synthesis.
- Coronary artery calcium and plaque prevalence studies in HIV-positive individuals need meta-analysis.
Purpose of the Study:
- To synthesize data on coronary artery calcium and coronary plaque in people living with HIV through meta-analyses.
- To compare the prevalence and progression of subclinical atherosclerosis between HIV-positive and HIV-negative individuals.
- To identify factors influencing cardiovascular disease burden in the HIV population.
Main Methods:
- Systematic literature search across electronic databases.
- Data abstraction using standardized forms from 43 reports (27 unique studies).
- Meta-analysis of pooled estimates from 10,867 participants (6,699 HIV-positive, 4,168 HIV-negative).
Main Results:
- Similar prevalence of coronary artery calcium (>0) between HIV-positive (45%) and HIV-negative (52%) individuals, which became non-significant after adjusting for Framingham Risk Score.
- Higher prevalence of noncalcified plaque in HIV-positive (49%) versus HIV-negative (20%) participants (OR 1.23, 95% CI 1.08-1.38).
- HIV-positive participants were younger and had lower Framingham Risk Scores than HIV-negative participants.
Conclusions:
- People living with HIV have a significantly higher prevalence of noncalcified coronary plaques.
- The prevalence of coronary artery calcium is similar between HIV-positive and HIV-negative individuals.
- Further studies on coronary artery calcium and plaque progression are essential to fully understand subclinical atherosclerosis in people living with HIV.
Abstract:
Background Studies have reported that people living with HIV have higher burden of subclinical cardiovascular disease, but the data are not adequately synthesized. We performed meta-analyses of studies of coronary artery calcium and coronary plaque in people living with HIV. Methods and Results We performed systematic search in electronic databases, and data were abstracted in standardized forms. Study-specific estimates were pooled using meta-analysis. 43 reports representing 27 unique studies and involving 10 867 participants (6699 HIV positive, 4168 HIV negative, mean age 52 years, 86% men, 32% Black) were included. The HIV-positive participants were younger (mean age 49 versus 57 years) and had lower Framingham Risk Score (mean score 6 versus 18) compared with the HIV-negative participants. The pooled estimate of percentage with coronary artery calcium >0 was 45% (95% CI, 43%-47%) for HIV-positive participants, and 52% (50%-53%) for HIV-negative participants. This difference was no longer significant after adjusting for difference in Framingham Risk Score between the 2 groups. The odds ratio of coronary artery calcium progression for HIV-positive versus -negative participants was 1.64 (95% CI, 0.91-2.37). The pooled estimate for prevalence of noncalcified plaque was 49% (95% CI, 47%-52%) versus 20% (95% CI, 17%-23%) for HIV-positive versus HIV-negative participants, respectively. Odds ratio for noncalcified plaque for HIV-positive versus -negative participants was 1.23 (95% CI, 1.08-1.38). There was significant heterogeneity that was only partially explained by available study-level characteristics. Conclusions People living with HIV have higher prevalence of noncalcified coronary plaques and similar prevalence of coronary artery calcium, compared with HIV-negative individuals. Future studies on coronary artery calcium and plaque progression can further elucidate subclinical atherosclerosis in people living with HIV.
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